Rare case of Velvety Palms reported in NEJM

Dr Denis Miyashiro, and Dr Jose A. Sanches, at Universidade de São Paulo, São Paulo, Brazil have reported a rare case of Velvety Palms. The case has appeared in the New England Journal of Medicine.

Velvety palms or acanthosis nigricans of the palm is an uncommon cutaneous marker of internal malignancy. Tripe is a food preparation made from the rugose surface of the bovine foregut. Acanthosis palmaris mimics that, with a thick and moss-like appearance. The term was first coined the term in 1977 by Clarke.

It usually occurs in association with an underlying malignancy, gastric and lung being the most common but it also has been reported without malignancy. But the identification of tripe palms or velvety palms should always initiate further investigations to exclude gastric, lung or other malignancies.

A 73-year-old woman who had a smoking history of 30 pack-years presented to the dermatology clinic with pruritic and painful lesions on the palms of her hands that had first appeared 9 months earlier. She reported a cough that had been present for 1 year and a weight loss of 5 kg over the past 4 months.

Her physical examination revealed sharp demarcation of the folds in the lines of her hands in addition to a velvety appearance of palmar surfaces and ridging of the skin (Panel A). This condition, known as tripe palms, is closely associated with cancer, particularly lung and gastric cancer. Computed tomography of the chest (Panel B), abdomen, and pelvis was performed and revealed an irregular nodule in the left upper lobe and enlarged mediastinal lymph nodes. Examination of the biopsy specimens of the nodule and mediastinal nodes confirmed the diagnosis of adenocarcinoma. Chemotherapy and radiation therapy were initiated. Tripe palm lesions may resolve with treatment of underlying cancer; however, the lesions in this patient did not regress with chemotherapy or with the application of 10% urea-containing ointment. Six months after presentation, cancer had progressed, and the patient began a second-line chemotherapy regimen.

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DOI: 10.1056/NEJMicm1902529